C3.1 R4(h): Provide continuity of care from in-hospital to outpatient setting #3

Discharge counselling for a 29 yo male admitted with psychosis

  • Counselled about medications, indications, regimens, drug interactions and side effects
    • In hospital, patient was on phenytoin 100mg po TID
      → Counselled that being discharged on 200mg AM and 100mg HS to ease compliance
    • Patient stated that when he was started on paliperidone, he started to feel tired in the morning but awake at night (typically sleeps at 2am for 12 hours)
      → Discussed other factors that could be affecting sleep
      → Discussed non-drug measures for sleep
      → Discussed shortening sleeping time, in order to make it easier to sleep at an earlier time and the importance of having a regular sleeping schedule
      → Discussed that if this was an ongoing and intolerable issue, despite adequate attempts at managing sleep – to discuss with his physician
  • Confirmed the community pharmacy that the discharge prescription was faxed to is correct
    • Patient does not remember the community pharmacy he usually goes to
    • Worked with patient to figure out what his regular community pharmacy is
    • Called and confirmed community pharmacy that he is a patient there and have been recently filling medications there PTA. Notified community pharmacy that patient is being discharged today
    • Contacted community pharmacy that the discharge prescription was originally faxed to and cancelled prescription
    • Faxed discharge prescription to patient’s regular community pharmacy and documented changes
  • Patient did not want any patient information handouts. Aware that his community pharmacy and physician is a good resource for any information/questions

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